A clinical algorithm to identify HIV patients at high risk for incident active tuberculosis: A prospective 5-year cohort study
Journal
PLoS ONE
Journal Volume
10
Journal Issue
8
Pages
e0135801
Date Issued
2015
Author(s)
Lee S.S.-J.
Lin H.-H.
Tsai H.-C.
Su I.-J.
Yang C.-H.
Sy C.-L.
Wu K.-S.
Chen J.-K.
Chen Y.-S.
Abstract
Background Predicting the risk of tuberculosis (TB) in people living with HIV (PLHIV) using a single test is currently not possible. We aimed to develop and validate a clinical algorithm, using baseline CD4 cell counts, HIV viral load (pVL), and interferon-gamma release assay (IGRA), to identify PLHIV who are at high risk for incident active TB in low-to-moderate TB burden settings where highly active antiretroviral therapy (HAART) is routinely provided. Materials and Methods A prospective, 5-year, cohort study of adult PLHIV was conducted from 2006 to 2012 in two hospitals in Taiwan. HAART was initiated based on contemporary guidelines (CD4 count < = 350/μL). Cox regression was used to identify the predictors of active TB and to construct the algorithm. The validation cohorts included 1455 HIV-infected individuals fromprevious published studies. Area under the receiver operating characteristic (ROC) curve was calculated. Results Seventeen of 772 participants developed active TB during a median follow-up period of 5.21 years. Baseline CD4 < 350/μL or pVL ? 100,000/mL was a predictor of active TB (adjusted HR 4.87, 95% CI 1.49-15.90, P = 0.009). A positive baseline IGRA predicted TB in patients with baseline CD4 ? 350/μL and pVL < 100,000/mL (adjusted HR 6.09, 95% CI 1.52-24.40, P = 0.01). Compared with an IGRA-alone strategy, the algorithm improved the sensitivity from 37.5% to 76.5%, the negative predictive value from 98.5%to 99.2%. Compared with an untargeted strategy, the algorithm spared 468 (60.6%) from unnecessary TB preventive treatment. Area under the ROC curve was 0.692 (95% CI: 0.587-0.798) for the study cohort and 0.792 (95% CI: 0.776-0.808) and 0.766 in the 2 validation cohorts. ? 2015 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
antiretrovirus agent; BCG vaccine; adult; aged; Article; BCG vaccination; CD4 lymphocyte count; cohort analysis; controlled study; diagnostic test accuracy study; extrapulmonary tuberculosis; female; high risk patient; highly active antiretroviral therapy; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; incidence; infection risk; interferon gamma release assay; intermethod comparison; major clinical study; male; miliary tuberculosis; predictive value; process development; prospective study; receiver operating characteristic; risk assessment; risk factor; sensitivity analysis; skin tuberculosis; Taiwan; tuberculosis; tuberculous meningitis; tuberculous peritonitis; tuberculous pleurisy; validation process; virus load; AIDS-Related Opportunistic Infections; algorithm; complication; HIV Infections; Human immunodeficiency virus; middle aged; pathogenicity; procedures; tuberculosis; virology; young adult; Adult; Aged; AIDS-Related Opportunistic Infections; Algorithms; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Female; HIV; HIV Infections; Humans; Incidence; Interferon-gamma Release Tests; Male; Middle Aged; Prospective Studies; Risk Factors; Taiwan; Tuberculosis; Viral Load; Young Adult
Publisher
Public Library of Science
Type
journal article